I am posting for my mother and hoping to get some valuable input. She is a 63 year old white female. Aside from high blood pressure and high cholesterol and fatty liver, she has been relatively healthy. There's no cancer in the family. Her father died from kidney failure in his 80s.
For the past 6 months, give or take, she has been having pain in her back and legs. She thought maybe it was from her job. She is a nurse in a long-term care facility and moves lots of patients. She also had a slip down a few stairs a while back that caused her some pain in her back. She had x-rays / MRI and everything was fine aside from spinal stenosis.
Her last set of lab work revealed an elevated BUN and creatinine, but it had been higher in past. I don't know the exact values. A physicians assistant ordered an electrophoresis thinking maybe she was in the beginning kidney failure. Not knowing what this test was, my Mom looked online and saw it was for multiple myeloma. Her results came back as follows. Her beta 1 was elevated and gamma was decreased as follows.
Protein total: 6.8
Albumin: 4.1 reference (3.8 - 4.8 g/dl)
Alpha 1 globulin: 0.2. Reference( 0.2 to 0.3)
Alpha 2 globulin: 0.7 reference (0.5 - 0.9)
Gamma globulin: 0.7 reference (0.8 - 1.7)
Beta 1 globulin: 0.7 reference (0.4-0.6)
Beta 2 globulin: 0.4 reference (0.2-0.5)
So after this test came back the doctor ordered immunofixation. This came back as follows:
"Immunofixation electrophoresis demonstrates the presence of IgA lambda monoclonal gammopathy"
Also got these results with it:
Free Kappa: 20.5 reference (3.3 - 19.4)
Free Lambda: 53.4 (5.7 to 26.3)
Free Kappa/Lambda Ratio: 0.38. Reference (0.26 - 1.65)
My mom asked the doctor if she thought she had multiple myeloma. The doctor told her she thinks its kidney related, said her ratio was normal, but that she wants her to see a hematologist to be sure it isn't multiple myeloma.
I am a registered nurse and cannot make sense of these labs. I just want to know honest opinions here. Could this be the beginning of kidney failure, as the doctor thinks, or is this more likely multiple myeloma?
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Re: Immunofixation shows IgA lambda gammopathy
Hi Ashleynicole,
Welcome to the forum.
It looks like your mother's protein electrophoresis was a serum (blood) protein electrophoresis, rather than a urine-based test. Was there any M-spike or abnormal protein band reported with the electrophoresis results?
Also, what are her immunoglobulin (IgG, IgA, and IgM) levels, particularly her IgA, and do you happen to know her calcium, hemoglobin, and creatinine levels?
It would be useful to know some of the results I just asked about before making guesses as to whether this is likely to be multiple myeloma, or something more benign. That said, nothing you've shared so far jumps out and screams "this is multiple myeloma!". The monoclonal protein that was detected with the immunofixation test, for example, might be transient, or could signal a very early stage of monoclonal gammopathy of undetermined significance (MGUS), a myeloma precursor that in most cases never progresses to multiple myeloma.
Welcome to the forum.
It looks like your mother's protein electrophoresis was a serum (blood) protein electrophoresis, rather than a urine-based test. Was there any M-spike or abnormal protein band reported with the electrophoresis results?
Also, what are her immunoglobulin (IgG, IgA, and IgM) levels, particularly her IgA, and do you happen to know her calcium, hemoglobin, and creatinine levels?
It would be useful to know some of the results I just asked about before making guesses as to whether this is likely to be multiple myeloma, or something more benign. That said, nothing you've shared so far jumps out and screams "this is multiple myeloma!". The monoclonal protein that was detected with the immunofixation test, for example, might be transient, or could signal a very early stage of monoclonal gammopathy of undetermined significance (MGUS), a myeloma precursor that in most cases never progresses to multiple myeloma.
Re: Immunofixation shows IgA lambda gammopathy
I do not have with me her BUN / creatinine, hemoglobin, or calcium results, but I will get them. I do know her BUN / creatinine are elevated, but the doctor said they aren't as high as they have been before. The doctor suggested my Mom drink more water because she lives off pop and thought maybe she could be dehydrated slightly. The doctor is leaning towards a kidney issue but cannot rule out myeloma yet.
Her tests were serum, not urine.
She has not had any testing of IgM, IgA, IgG specifically.
She asked her doctor about an M-spike, to which the doctor replied, "Its not there." I thought monoclonal gammopathy was an M-spike? I know the interpretation on her immunofixation showed IgA lambda monoclonal gammopathy. This is all really confusing and beyond any of my prior nursing knowledge.
I also feel its worth mentioning that she complains of neuropathy. She describes it as "hot pins being stuck in my skin."
I will find out more info on her labs and report back.
Her tests were serum, not urine.
She has not had any testing of IgM, IgA, IgG specifically.
She asked her doctor about an M-spike, to which the doctor replied, "Its not there." I thought monoclonal gammopathy was an M-spike? I know the interpretation on her immunofixation showed IgA lambda monoclonal gammopathy. This is all really confusing and beyond any of my prior nursing knowledge.
I also feel its worth mentioning that she complains of neuropathy. She describes it as "hot pins being stuck in my skin."
I will find out more info on her labs and report back.
Re: Immunofixation shows IgA lambda gammopathy
I am with Terry that nothing screams multiple myeloma in this case. But it would be good to get evaluated by a hematologist that specializes in multiple myeloma given the immunofixation results and the presence of neuropathy.
I might also consider getting a 24 hour urine test to see if a urine M-spike (which is very different than a serum M-spike) shows up, or if there is any excess protein in the urine that might still suggest something like amyloidosis.
If you let us know what city your mom is in, folks on the forum can recommend some facilities to seek out that have multiple myeloma specialists.
I might also consider getting a 24 hour urine test to see if a urine M-spike (which is very different than a serum M-spike) shows up, or if there is any excess protein in the urine that might still suggest something like amyloidosis.
If you let us know what city your mom is in, folks on the forum can recommend some facilities to seek out that have multiple myeloma specialists.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Immunofixation shows IgA lambda gammopathy
We are located in the Wheeling, West Virginia area, near Pittsburgh, Pennsylvania, and Columbus, Ohio.
Bad thing is she doesn't have insurance at the moment. She cut back on her hours at work because of back pain she attributed to moving patients. So they took her insurance since she isn't full time.
Bad thing is she doesn't have insurance at the moment. She cut back on her hours at work because of back pain she attributed to moving patients. So they took her insurance since she isn't full time.
Re: Immunofixation shows IgA lambda gammopathy
I got her recent lab work in addition to what I posted on my first post:
Hemoglobin: 13.9 g/dl
Creatinine: 1.06 mg/dl
BUN: 20 mg/dl
EGFR: 52
Calcium: 9.3 mg/dl
And I'll just add in her lipid profile just in case there could be any significance to something.
Cholesterol: 288
Triglycerides: 708
HDL: 40
She said she was off her cholesterol medication for a couple weeks and this could be why it's so elevated.
Doctor told her the test they did on her urine was better than the serum test, but didn't give specific values.
Hemoglobin: 13.9 g/dl
Creatinine: 1.06 mg/dl
BUN: 20 mg/dl
EGFR: 52
Calcium: 9.3 mg/dl
And I'll just add in her lipid profile just in case there could be any significance to something.
Cholesterol: 288
Triglycerides: 708
HDL: 40
She said she was off her cholesterol medication for a couple weeks and this could be why it's so elevated.
Doctor told her the test they did on her urine was better than the serum test, but didn't give specific values.
Re: Immunofixation shows IgA lambda gammopathy
Hi Ashleynicole,
So your mother's hemoglobin, creatinine, and calcium levels – which are key results when it comes to a multiple myeloma diagnosis – are all in the normal range. The fact that the levels are normal does not rule out the possibility of multiple myeloma, but it makes it less likely that your mother has active, symptomatic disease requiring treatment.
Granted, your mother's BUN level is on the high side. But, as you probably know more than I do, kidney problems are not the only thing that can cause a high BUN level.
You wrote that "Doctor told her the test they did on her urine was better than the serum test." This suggests there was no sign of a monoclonal protein in her urine. That is a good sign. However, it does not rule out the possibility that your mother is producing very low levels of a monoclonal protein. It could be that her kidneys are doing their job and filtering out whatever monoclonal protein her body is producing.
I have to say that I'm leaning to suggesting that perhaps your mother should wait a month or two and then have some of the key blood tests done again. To me, it seems like your mother either does not have a plasma cell disorder at all – and something else is causing the (transient?) kidney and back issues – or she has a very low level case of light-chain monoclonal gammopathy of undetermined significance (MGUS).
But perhaps others here see things differently.
As far as myeloma specialists go in your area, Ohio State is probably your best bet. They have a number of myeloma specialists, and there really aren't any hematology-oncology specialists focused mainly on myeloma in the Pittsburgh area.
Finally, in case you haven't seen it already, this article describes the criteria for a multiple myeloma diagnosis. In addition to "active" multiple myeloma, which is usually treated, there is also smoldering multiple myeloma and MGUS, the latter two conditions sometimes described as multiple myeloma "precursor diseases."
So your mother's hemoglobin, creatinine, and calcium levels – which are key results when it comes to a multiple myeloma diagnosis – are all in the normal range. The fact that the levels are normal does not rule out the possibility of multiple myeloma, but it makes it less likely that your mother has active, symptomatic disease requiring treatment.
Granted, your mother's BUN level is on the high side. But, as you probably know more than I do, kidney problems are not the only thing that can cause a high BUN level.
You wrote that "Doctor told her the test they did on her urine was better than the serum test." This suggests there was no sign of a monoclonal protein in her urine. That is a good sign. However, it does not rule out the possibility that your mother is producing very low levels of a monoclonal protein. It could be that her kidneys are doing their job and filtering out whatever monoclonal protein her body is producing.
I have to say that I'm leaning to suggesting that perhaps your mother should wait a month or two and then have some of the key blood tests done again. To me, it seems like your mother either does not have a plasma cell disorder at all – and something else is causing the (transient?) kidney and back issues – or she has a very low level case of light-chain monoclonal gammopathy of undetermined significance (MGUS).
But perhaps others here see things differently.
As far as myeloma specialists go in your area, Ohio State is probably your best bet. They have a number of myeloma specialists, and there really aren't any hematology-oncology specialists focused mainly on myeloma in the Pittsburgh area.
Finally, in case you haven't seen it already, this article describes the criteria for a multiple myeloma diagnosis. In addition to "active" multiple myeloma, which is usually treated, there is also smoldering multiple myeloma and MGUS, the latter two conditions sometimes described as multiple myeloma "precursor diseases."
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